Provider Demographics
NPI:1609363639
Name:CASTLEBERRY, ANDREA NICHOLE (OWNER)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:NICHOLE
Last Name:CASTLEBERRY
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1336
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-1336
Mailing Address - Country:US
Mailing Address - Phone:757-581-1654
Mailing Address - Fax:757-533-5499
Practice Address - Street 1:1035 W 25TH ST # G1
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-1000
Practice Address - Country:US
Practice Address - Phone:757-533-5455
Practice Address - Fax:757-533-5499
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health